Organization of internal control of quality of medical care (Faculty Clinics of Irkutsk State Medical University)

Currently, there is no normative document at the federal level that determines the format of the organization of internal control of medical care quality in a medical organization. The system of standardization in the sphere of public health of the Russian Federation remains incomplete. In this regard, in the multidisciplinary medical organization, innovative approaches have been developed and implemented in the management of the medical care quality and ensuring the safety of medical activities: the development of a number of local regulatory documents; strengthening the expert institute (setting up a department for quality control and safety of medical activities); increasing the role of the internal expertise of the quality of medical care; standardization of medical care; improving the organization of work of middle and junior medical links; strict adherence to the three-stage internal quality control with the obligatory presence of self-control when monitoring the quality of work of medical, middle and junior medical personnel. The authors show the dynamics of the main indicators of the quality of care at the stages before and after the introduction of new approaches to improve the internal quality control of medical care. The presented data testify to the effectiveness and expediency of the proposed measures

Improvement of radiopurity level of enriched 116^{116}CdWO4_4 and ZnWO4_4 crystal scintillators by recrystallization

As low as possible radioactive contamination of a detector plays a crucial role to improve sensitivity of a double beta decay experiment. The radioactive contamination of a sample of $^{116}$CdWO$_4$ crystal scintillator by thorium was reduced by a factor $\approx 10$, down to the level 0.01 mBq/kg ($^{228}$Th), by exploiting the recrystallization procedure. The total alpha activity of uranium and thorium daughters was reduced by a factor $\approx 3$, down to 1.6 mBq/kg. No change in the specific activity (the total $\alpha$ activity and $^{228}$Th) was observed in a sample of ZnWO$_4$ crystal produced by recrystallization after removing $\approx 0.4$ mm surface layer of the crystal.Comment: 14 pages, 5 figures and 2 table

Low-Temperature Mobility of Surface Electrons and Ripplon-Phonon Interaction in Liquid Helium

The low-temperature dc mobility of the two-dimensional electron system localized above the surface of superfluid helium is determined by the slowest stage of the longitudinal momentum transfer to the bulk liquid, namely, by the interaction of surface and volume excitations of liquid helium, which rapidly decreases with temperature. Thus, the temperature dependence of the low-frequency mobility is \mu_{dc} = 8.4x10^{-11}n_e T^{-20/3} cm^4 K^{20/3}/(V s), where n_e is the surface electron density. The relation T^{20/3}E_\perp^{-3} << 2x10^{-7} between the pressing electric field (in kV/cm) and temperature (in K) and the value \omega < 10^8 T^5 K^{-5}s^{-1} of the driving-field frequency have been obtained, at which the above effect can be observed. In particular, E_\perp = 1 kV/cm corresponds to T < 70 mK and \omega/2\pi < 30 Hz.Comment: 4 pages, 1 figur

The efficiency of tear substitute therapy at dysfunction tear basic secretion

Purpose: to evaluate the efficiency and tolerance of drops replacing tear with hyaluronic acid 0.15% (Hylabak, thea, France) for the treatment of tear film diseases, in particular blepharoconjunctival form of dry eye syndrome.Methods: 32 patients (range 38 to 72 years) with blepharoconjunctival form of dry eye syndrome were treated lubricant Hylabak 2-4 times a day during 7-30 days.Results: After treatment was detected the elimination of complaints in 30 of 32 people, increasing the stability of the tear film (increasing values of the samples Norn test from 7.3 ±0.5 to 10.1±0.6 seconds), as well as normalization of Schirmer test (from 8.8±0.4 to 15.2±0.5 mm).Conclusion: the study was showed high efficacy of lubricant Hylabak and subjective tolerability at blepharoconjunctival form of dry eye syndrome

Nomenclatural standards, voucher specimens and genetic passports of potato cultivars created in the Siberian and Ural breeding centers

The present paper discusses methodological approaches to the creation of nomenclatural standards and genetic passports for Russian cultivars, currently being developed at the N.I. Vavilov Institute of Plant Genetic Resources (VIR) in collaboration with different breeding research centers. Plant material of potato cultivars bred in the Siberian Research Institute of Plant Cultivation and Breeding was collected by the cultivar creator A.D. Safonova in the experimental field of this institute and transferred to the VIR herbarium for preparation of their nomenclatural standards. Plant shoots and tubers of potato cultivars bred in other Siberian research centers in collaboration with the A.G. Lorkh All-Russian Research Institute of Potato Farming (VNIIKH) was collected by the representative of this institute in the experimental field of VNIIKH. As a result of joint research, nomenclatural standards were accomplished for 11 cultivars, namely ‘Аntonina’, ‘Zlatka’, ‘Lina’, ‘Lûbava’, ‘Nakra’, ‘Pamâti Rogačeva’, ‘Sarovskij’, ‘Safo’, ‘Solnečnyj’, ‘Tuleevskij’, ‘Ûna’** bred in five different Siberian breeding institutes including cultivars developed in collaboration with VNIIKH. Nomenclatural standards were prepared according to the ‘International Code of Nomenclature for Cultivated Plants’. DNA samples isolated from nomenclatural standards were used for preparation of genetic passports of these 11 cultivars. These genetic passports include information of the polymorphism of eight chromosome-specific microsatellites, data on the markers of 11 R-genes conferring resistance to various harmful organisms, as well as the information about cytoplasm types. Voucher specimens of additional three Siberian cultivars ‘Kemerovčanin’, ‘Kuznečanka’, ‘Tanaj’ and five Ural cultivars ‘Аlâska’, ‘Bravo’, ‘Irbitskij’, ‘Lûks’, ‘Terra’ from the Ural Research Institute for Agriculture were also registered in the VIR herbarium collection. For these eight cultivars, the genetic passports were not issued, but the results of SSR genotyping and molecular screening of voucher specimens performed with the same set of the DNA markers are presented in this report. A similar set of DNA markers was used for genotyping cultivar accessions from the in vitro and field collections of various institutes as well as cultivar specimens from eco-geographical tests performed within the framework of the Comprehensive Research Plan of the subprogram “Development of potato breeding and seed production in the Russian Federation”. The comparison of cultivar genetic passport data with genotyping results of specimens having the same name, but obtained from different sources made it possible to verify this plant material

The mathematical simulation of the temperature fields of building envelopes under permanent frozen soil conditions

The physical-mathematical model of the thermal state of the aired technical underground taking into account the air exchange and design features of construction under permanent frozen soil conditions has been suggested. The computational scheme of the temperature fields prediction of building envelopes of projected buildings and soil under and nearby buildings has been developed. The numerical simulation of the temperature fields of building envelopes changes was conducted during a year. The results of the numerical simulation showed that the heat coming from the technical undergrounds and through the walls does not influence the temperature field of the soil neither under a building nor at a distance from it

X-ray absorption spectroscopy systematics at the tungsten L-edge

A series of mononuclear six-coordinate tungsten compounds spanning formal oxidation states from 0 to +VI, largely in a ligand environment of inert chloride and/or phosphine, has been interrogated by tungsten L-edge X-ray absorption spectroscopy. The L-edge spectra of this compound set, comprised of [W&lt;sup&gt;0&lt;/sup&gt;(PMe&lt;sub&gt;3&lt;/sub&gt;)&lt;sub&gt;6&lt;/sub&gt;], [W&lt;sup&gt;II&lt;/sup&gt;Cl&lt;sub&gt;2&lt;/sub&gt;(PMePh&lt;sub&gt;2&lt;/sub&gt;)&lt;sub&gt;4&lt;/sub&gt;], [W&lt;sup&gt;III&lt;/sup&gt;Cl&lt;sub&gt;2&lt;/sub&gt;(dppe)&lt;sub&gt;2&lt;/sub&gt;][PF&lt;sub&gt;6&lt;/sub&gt;] (dppe = 1,2-bis(diphenylphosphino)ethane), [W&lt;sup&gt;IV&lt;/sup&gt;Cl&lt;sub&gt;4&lt;/sub&gt;(PMePh&lt;sub&gt;2&lt;/sub&gt;)&lt;sub&gt;2&lt;/sub&gt;], [W&lt;sup&gt;V&lt;/sup&gt;(NPh)Cl&lt;sub&gt;3&lt;/sub&gt;(PMe&lt;sub&gt;3&lt;/sub&gt;)&lt;sub&gt;2&lt;/sub&gt;], and [W&lt;sup&gt;VI&lt;/sup&gt;Cl&lt;sub&gt;6&lt;/sub&gt;] correlate with formal oxidation state and have usefulness as references for the interpretation of the L-edge spectra of tungsten compounds with redox-active ligands and ambiguous electronic structure descriptions. The utility of these spectra arises from the combined correlation of the estimated branching ratio (EBR) of the L&lt;sub&gt;3,2&lt;/sub&gt;-edges and the L&lt;sub&gt;1&lt;/sub&gt; rising-edge energy with metal Z&lt;sub&gt;eff&lt;/sub&gt;, thereby permitting an assessment of effective metal oxidation state. An application of these reference spectra is illustrated by their use as backdrop for the L-edge X-ray absorption spectra of [W&lt;sup&gt;IV&lt;/sup&gt;(mdt)&lt;sub&gt;2&lt;/sub&gt;(CO)&lt;sub&gt;2&lt;/sub&gt;] and [W&lt;sup&gt;IV&lt;/sup&gt;(mdt)&lt;sub&gt;2&lt;/sub&gt;(CN)&lt;sub&gt;2&lt;/sub&gt;]&lt;sup&gt;2–&lt;/sup&gt; (mdt&lt;sup&gt;2–&lt;/sup&gt; = 1,2-dimethylethene-1,2-dithiolate), which shows that both compounds are effectively W&lt;sup&gt;IV&lt;/sup&gt; species. Use of metal L-edge XAS to assess a compound of uncertain formulation requires: 1) Placement of that data within the context of spectra offered by unambiguous calibrant compounds, preferably with the same coordination number and similar metal ligand distances. Such spectra assist in defining upper and/or lower limits for metal Z&lt;sub&gt;eff&lt;/sub&gt; in the species of interest; 2) Evaluation of that data in conjunction with information from other physical methods, especially ligand K-edge XAS; 3) Increased care in interpretation if strong π-acceptor ligands, particularly CO, or π-donor ligands are present. The electron-withdrawing/donating nature of these ligand types, combined with relatively short metal-ligand distances, exaggerate the difference between formal oxidation state and metal Z&lt;sub&gt;eff&lt;/sub&gt; or, as in the case of [W&lt;sup&gt;IV&lt;/sup&gt;(mdt)&lt;sub&gt;2&lt;/sub&gt;(CO)&lt;sub&gt;2&lt;/sub&gt;], add other subtlety by modulating the redox level of other ligands in the coordination sphere

Аутоиммунные поражения печени у пациентов с болезнью Шёгрена, ассоциированной с антицентромерными антителами

Objective: to determine the frequency, spectrum and severity of liver affection in anti-centromere antibodies (ACA) positive patients with primary Sjogren's syndrome (pSS).Patients and methods. 119 ACA-positive patients with pSS were included in the study, 37 (31%) of them had signs of liver damage, 3 of these patients were excluded from the study (2 had cholelithiasis, 1 had viral hepatitis B). Signs of autoimmune liver damage were found in 34 (28.6%) patients, most of them were seropositive for antimitochondrial antibodies (AMA). The diagnosis of primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) was established according to the recommendations of the American Association for the Study of Liver Diseases, the Russian Gastroenterological Association and the Russian Society for the Study of the Liver. In 5 (14.7%) patients the cause of cholestasis remained unspecified.Results and discussion. AMA were found in 73.5% of patients, elevated serum IgM levels – in 57.6%. Clinically liver damage in most cases was characterized by an asymptomatic, slowly progressive course without a dramatic increase of symptoms over time. Liver cirrhosis was found in 14.7% of patients. According to clinical, laboratory and morphological manifestations, PBC was diagnosed in 21 patients, 4 of them also had a cross syndrome with AIH. AMA-negative PBC was found in 3 patients and isolated AIH – in 1. In most cases, histological stage I of PBC was detected. During follow-up, median of 7 years (range from 2 to 15 years), in 7 patients with stage I PBC and in 7 AMA-positive patients without functional liver disorders no clinical, laboratory or instrumental progression of liver damage was noted. In this regard, it was suggested that these patients have epitheliitis of the biliary ducts as manifestation of glandular affection in pSS, and not true PBC.Conclusion. Autoimmune liver lesions are detected in 28.6% of ACA-positive patients with pSS, most (41.2%) of them develop epitheliitis of the biliary ducts as pSS manifestation or a combination of pSS with PBC (with the same frequency), less often PBC / AIH cross syndrome is diagnosed. PBC / pSS-related epitheliitis of the biliary ducts in ACA-positive patients is characterized by a slowly progressive asymptomatic course in most cases and rarely leads to the development of liver cirrhosis.Цель настоящего исследования – определить частоту, спектр и тяжесть течения поражений печени у позитивных по антицентромерным антителам (АЦА) пациентов с болезнью Шёгрена (БШ).Пациенты и методы. У 37 (31%) из 119 включенных в исследование АЦА-позитивных пациентов с БШ при обследовании выявлены признаки поражения печени, 3 из них были исключены из исследования (у 2 имелась желчнокаменная болезнь, у 1 – вирусный гепатит В). Признаки аутоиммунного поражения печени обнаружены у 34 (28,6%) больных, большинство из которых были серопозитивны по антимитохондриальным антителам (АМА). Диагноз первичного билиарного холангита (ПБХ) и аутоиммунного гепатита (АИГ) устанавливался согласно рекомендациям Американской ассоциации по изучению заболеваний печени, Российской гастроэнтерологической ассоциации и Российского общества по изучению печени. Причина холестаза у 5 (14,7%) пациентов осталась неуточненной.Результаты и обсуждение. АМА обнаружены у 73,5% пациентов, повышение уровня IgM – у 57,6%. Клинически поражение печени в большинстве случаев характеризовалось бессимптомным медленно прогрессирующим течением, как правило, без выраженного нарастания симптомов в динамике. Признаки цирроза выявлены у 14,7% пациентов. На основании клинико-лабораторно-морфологических проявлений ПБХ диагностирован у 21 больного, у 4 из которых также имелся перекрестный синдром с АИГ. АМА-негативный ПБХ установлен у 3 пациентов и изолированный АИГ – у 1. В большинстве случаев определялась I гистологическая стадия ПБХ. При динамическом наблюдении, медиана которого составила 7 лет (мин. 2 года, макс. 15 лет), у 7 пациентов с I стадией ПБХ и у 7 АМА-позитивных больных без функциональных нарушений печени в течение всего периода наблюдения клинического и лабораторно-инструментального прогрессирования поражения печени не отмечено. В связи с этим сделано предположение, что у данных пациентов имеется эпителиит билиарных протоков как проявление железистых поражений при БШ, а не истинный ПБХ.Заключение. Аутоиммунные поражения печени выявляются у 28,6% АЦА-позитивных пациентов с БШ, у большинства из них с одинаковой частотой (41,2%) развиваются эпителиит билиарных протоков в рамках БШ либо сочетание БШ с ПБХ, реже диагностируется перекрестный синдром ПБХ/АИГ. ПБХ/эпителиит билиарных протоков в рамках БШ у АЦА-позитивных пациентов в большинстве случаев характеризуется медленно прогрессирующим бессимптомным течением и редко приводит к развитию цирроза печени

Diagnosis of IgG4 - related ophthalmic disease in a group of patients with various lesions of the eye and orbits

Purpose of the study. To provide demographic, clinical, laboratory, ultrasound, radiological, morphological/ immunomorphological phenotype of IgG4-related ophthalmic diseases, which allowsmaking a differential diagnosis with granulomatous, autoimmune, inflammatory, endocrine and hematologic diseases affecting the eye and orbits. Materials and methods. From 2004 to 2016 108 (78.2%) of the 138 patients were diagnosed with non-tumoral lesions of eye and orbits. In 48 patients (35%) at admission and 5 patients in the follow were diagnosed IgG4-related ophthalmic disease. In the analysis of 82 (f-44, m-38) patients with IgG4-related disease, localization of lesions in orbit observed in 53 (f-36, m-17) and it was the most frequent involvement in patients with IgG4-related disease (64.5%). Only 7 patients had isolated IgG4-related ophthalmic disease, whereas 46 patients (87%) had involvement of 2-7 locations, as a manifestation of IgG4-related systemic disease.During the examination, the average age of patients with IgG4-related ophthalmic disease was 47.5 years (19-73 years). Median time to diagnosis was 52.8 months before 2004 and 36 months 2004-2016. Results. We noted the predominance of females in the ratio 2: 1 inthe group of patients with IgG4-related ophthalmic disease. Edema of the eyelids, nasal congestion (55-60%), tumor-like formations of the upper eyelids and increased lacrimation prevailed at the onset of the disease, whereas such functional impairment like limited mobility and pain in eyeballs, exophthalmos, ptosis and diplopia appeared later at 15-38% with a loss visual acuity in one case. Bilateral lesion (86%), mainly affecting the lacrimal glands (93.5%), infiltration of the extraocular muscles (83.5%) and retrobulbar tissue with a thickening of the optic nerve in one third of patients were the main localizations IgG4-related ophthalmic disease. Clinical symptoms were accompanied by the appearance of moderate inflammatory activity (38%), increased levels IgG (44%), IgG4(88%) and IgE (61%). Indicators of autoimmune disorders observed in 6-22% of patients, most often in patients with simultaneous involvement of the salivary glands. Significant lymphoplasmacytic infiltration (94%) with a ratio of plasma cells (IgG4/IgG) secreting IgG4> 40% (90%) with fibrosis formation (94%) and follicle formation (71%) with a moderate amount of eosinophils (34%) were the major morphological / immunomorphological manifestations of IgG4-related ophthalmic disease. Signs of vasculitis and obliterative phlebitis were found in a small amount of patients. Conclusion. Determination of elevated levels of IgG-4 / IgE in patients with edema, pseudotumor of the eyelid, sinusitis and increase of the palpebral lobe of the lacrimal gland suggests the presence of IgG4-related ophthalmic disease. Minimally invasive incisional biopsy of lacrimal glands and salivary glands followed by morphological / immunomorphological research is needed for the correct diagnosis. Diagnostic orbitotomy in ophthalmic hospitals in such cases is inexpedient, since it leads to the development of dry eye. Massive lymphoplasmacytic infiltration with IgG4 / IgG ratio more than 40%, advanced fibrosis in biopsiesof the orbits tissue or salivary glands when combined lesions are required for the making the diagnosis of IgG4-related ophthalmic disease